Spinal Symposium

Question 1

What are the most common causes of spinal cord injuries

Answer 1

• Fall
• RTA
• Sport
• Knocked over/collision/lifting
• Trauma
• Sharp trauma/assault

Question 2

Describe the features of a complete spinal injury

Answer 2

• No motor or sensory function distal to the lesion
• No anal squeeze
• No sacral sensation
• AISA grade A
• No chance of recovery

Question 3

Describe the features of an incomplete spinal injury

Answer 3

• Some function is present below site of injury

- More favourable prognosis overall

Question 4

What are the different patterns of injury in spinal cord injuries?

Answer 4

• Tetraplegia/quadriplegia
• Paraplegia
• Central cord syndrome
• Anterior cord syndrome
• Brown-Sequard syndrome

Question 5

Describe the features of tetraplegia

Answer 5

• Partial or total loss of use of all four limbs and the trunk
• Loss of motor/sensory function in cervical segments of the spinal cord
• Above C5 - respiratory failure due to loss of innervation of the diaphragm
• Spasticity (increased muscle tone)

Question 6

Describe the features of paraplegia

Answer 6

• Partial or total loss of use of the lower limbs
• Impairment or loss of motor/sensory function on thoracic, lumbar or sacral segments of the spinal cord
• Arm function spared
• Possible impairment of function in the trunk
• Bladder/bowel function affected
• Spasticity if injury above L1

Question 7

Describe the features of central cord syndrome

Answer 7

• Older patients
• Hyperextension injury
• Centrally cervical tracts more involved
• Weakness of arms > legs
• Perianal sensation and lower extremity power preserved

Question 8

Describe the features of anterior cord syndrome

Answer 8

• Hyperflexion injury
• Anterior compression fracture
• Damaged anterior spinal artery
• Fine touch and proprioception preserved
• Profound weakness

Question 9

Describe the features of Brown-Sequard syndrome

Answer 9

• Hemi-section of the cord
• Penetrating injuries
• Paralysis on affected side
• Loss of proprioception and fine discrimination
• Pain and temperature loss on the opposite side below the lesion

Question 10

How can spinal cord injuries be managed?

Answer 10

• Prevention of a secondary insult
• ABCD and ATLS
• Treat spinal or neurogenic shock
• Assess neurological function including PR and perianal sensation
• Log rolling

Question 11

What are the features of spinal shock?

Answer 11

• Transient depression of cord function below level of injury
• Flaccid paralysis
• Areflexia
• Lasts several hours to days

Question 12

What are the features of neurogenic shock?

Answer 12

• Hypotension
• Bradycardia
• Hypothermia
• Injuries above T6
• Secondary to disruption of sympathetic outflow

Question 13

What imaging should be done for a SCI?

Answer 13

• XR
• CT
• MRI: if neurological deficit or child

Question 14

When should surgical fixation be used?

Answer 14

Unstable fractures

Question 15

What is the long term management of SCI?

Answer 15

• SCI Unit
• Physio
• OT
• Psychological support
• Urological/sexual counselling

Question 16

What are the features of nerve root pain?

Answer 16

• Limb pain worse than back pain
• Pain in a nerve root distribution
• Root tension and compression signs
• Dermatomes and myotomes

Question 17

How can nerve root pain be managed?

Answer 17

• Most will settle within 3 months
• Physio
• Strong analgesia
• Referral after 12 weeks
• MRI

Question 18

What are the different types of disc problems?

Answer 18

• Bulge
• Protrusion
• Extrusion
• Sequestration (dessicated disc material free in the canal)

Question 19

How is cauda equina syndrome managed?

Answer 19

• SURGICAL EMERGENCY

- Admission, urgent MRI scna and emergency operation within 48 hrs

Question 20

What happens if cauda equina syndrome is left untreated for too long?

Answer 20

Permanent bladder and anal sphincter and incontinence

Question 21

What is the aetiology of cauda equina syndrome?

Answer 21

• Central lumber disc prolapse
• Tumours
• Trauma
• Infection
• Iatrogenic

Question 22

What are the clinical features of cauda equina syndrome?

Answer 22

• Injury or precipitating event
• Bilateral buttock and leg pain + varying dysaesthesiae + weakness
• Bowel or bladder dysfunction
• PR exam: saddle anaesthesia, loss of anal tone and anal reflex

Question 23

Which investigation should be done for cauda equina syndrome?

Answer 23

• MRI

- If contraindicated then lumbar CT myelogram

Question 24

What are the features of cervical and lumbar spondylosis?

Answer 24

• Degenerative change at facet joints, discs, ligaments etc.
• If severe can compress whole cord - causes myelopathy
• UMN signs in limbs (increased tone, brisk reflexes etc.)

Question 25

What are the features of spinal claudication?

Answer 25

- Usually bilateral - Sensory dysaesthesiae - Poss weakness - Takes several minutes to ease after stopping - Worse walking downhill

Question 26

How can lateral recess stenosis be treated>

Answer 26

- Non operative - Nerve root injection - Epidural injection - Surgery

Question 27

How can central stenosis be treated?

Answer 27

- Non-operative - Epidural steroid injection - Surgery

Question 28

How can foraminal stenosis be treated?

Answer 28

- Non-operative - Nerve root injection - Epidural injection - Surgery